Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Now, it’s worth noting that the study focused solely on the Veterans Health Administration’s EMR, which doubtless has quirks of its own. That being said, the analysis is worth a look.

To do the study, researchers used the Veterans Health Administration’s Informatics Patient Safety Office, which has tracked EMR safety issues since the VA’s EMR was implemented in 1999. Researchers chose 100 closed patient safety investigations related to the EMR that took place between August 2009 and May 2013, which covered 344 incidents.

Researchers analyzed not only safety problems related to EMR technology, but also human operational factors such as workflow demands, organizational guidelines and user behavior, according to a BMJ release.

After reviewing the data, researchers found that 74 events related to safety problems with EMR technology, including false alarms, computer glitches and system failures. They also discovered problems with “hidden dependencies,” situation which a change in one part of the EMR system inadvertently changed important aspects in another part of the system.

The data also suggested that 25 other events were related to the unsafe use of technology, including mistakes in interpreting screens or human input errors.

All told, 70% of the investigations had found at least two reasons for each problem.

Commonly found safety issues included data transmission between different parts of the EMR system, problems related to software upgrades and EMR information display issues (the most commonly identified problem), iHealthBeat noted.

After digging into this data, researchers recommended that healthcare organizations should build “a robust infrastructure to monitor and learn from” EMRs, because EMR-related safety concerns have complicated social and technical origins. They stressed that this infrastructure is valuable not only for providers with newly installed EMRs, but also for those with EMRs said that in place for a while, as both convey significant safety concerns.

They concede, however, that building such an infrastructure could prove quite difficult at this time, with organizations struggling with meaningful use compliance and the transition from ICD-9 to ICD-10.

However, the takeaway from this is that providers probably need to put safety monitoring — for both human and technical factors — closer to the top of their list of concerns. It stands to reason that both newly-installed and mature EMR implementations should face points of failure such as those described in the study, and they should not be ignored. (In the meantime, here’s one research effort going on which might be worth exploring.)

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

#THIS RT .@footyDoc it will get bettr, but we need leadership to demand improvement. #EMR designed for revenue capture not better healthcare

The last comment in this tweet is something I’ve hammered home over the years. It’s a simple concept when you hear it and everyone agrees. It also explains at least some of the frustration with EHR software in their current iterations. I’ve often wondered what an EMR designed for healthcare would look like instead of the EMR’s designed for revenue capture that we have today. I actually think we may get to see the answer to this in the concierge medicine area.

Two Strategies for the Integration of Patient-Generated Data into the EMR. Which Road to Travel? http://t.co/0EqTu7QfBm

This article by one of the smartest people in this space, Dr. Joseph Kvedar, is really well done. I’ve long been interested in the pathway to integrating patient collected data into the EMR. I’m excited to read that Partners is close to making it a reality. It’s definitely just the first step, but that’s how it all gets started. Dr. Kvedar does make an extra observation in the article about the 5% sickest patients that they want to target aren’t using mobile devices and health trackers. That’s an important observation that’s worthy of deeper consideration.

These signs have always bothered me. I appreciate Dr. Nick tweeting about it. I know we put up a sign like it 9 years ago when I first helped do an EMR implementation. We didn’t go as far as this sign, but definitely wanted them to understand the delay. There’s a fine line between good customer service and freaking out the patients. My favorite signs I’ve seen tout the EHR as the second coming of quality patient care. I hope the practices that put up these signs can live up to that promise.

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Ah, HIMSS. The frenetic pace. The ridiculously long exhibit hall. The aching feet. The Google Glass-ers. As I write this, day three for me is in full swing and I’ve finally managed to find some time to reflect on what I’ve seen, which includes a ridiculously long taxi queue at the airport, more pedicabs than I can count, beautiful weather and lots of familiar faces, which is what makes HIMSS so much fun. I’ve heard lots of buzzwords and sales talk, and seen only about an eighth of the exhibit hall, barely scratching the surface of what’s out there on the show floor.

Several common themes stand out based on the sessions and events I’ve been to, and the passions of those I’ve encountered. Whether it’s vendor breakfasts, social networking functions, exhibit elevator pitches or educational sessions, interoperability and engagement are still the buzzwords to beat. This particular HIMSS has given me a different perspective on each, and offered new insight into what’s happening with the Blue Button Connector. I’ll cover each of these in HIMSS Highlights posts over the next several weeks, starting with interoperability.

The industry seems far more realistic this year regarding interoperability – downright frustrated by the slow pace at which such a lofty goal is proceeding. Industry experts Brian Ahier and Shahid Shah perhaps expressed it best during a lively panel discussion at the Surescripts booth:

Putting vendors’ feet to the fire will certainly initiate a quick and painful reaction, but probably not a sustainable one. True momentum will occur only when providers get singed a bit, too. Panelist comments at a Dell / Intel breakfast on analytics for accountable care brought this into sharper focus for me. The fact that too many disparate EMRs (and thus too many vendors poised to cause inertia) are making it hard for analytics to successfully be adopted and utilized at an enterprise level, highlights a bigger problem related to hindsight and strategy.

From my perspective – that of an industry observer and commentator – it seems many providers felt compelled to purchase EMRs because the federal government offered them money to do so, and hopefully just as many were optimistic about the role technology would play in positively affecting patient outcomes. Vendors saw a great business opportunity and moved quickly to develop systems that met Meaningful Use criteria (not necessarily going for best-fit as related to workflow needs and usability). Neither group truly knew what they were in store for, especially regarding longer term plans for health information exchange.

Providers now find themselves wanting to move forward with health information exchange and greater interoperability, but slowed down by the very IT systems they were so insistent on purchasing just a few years ago. Vendors (some more than others) are hesitant to crack open their products to allow data to truly flow from one system to another, and who can blame them? The EMR market, in particular, is poised to shrink, which begs the question, who will survive? What companies will be around at HIMSS 15 and 16? Those who keep their systems siloed, like Epic? Or those who are trying to break down the silos, such as Common Well Alliance members like athenahealth and Greenway?

It makes me wonder if providers wouldn’t have been better served with just had a handful of EMRs to choose from around the time of HITECH, all guaranteed to evolve as needed and play nicely with each other in the interest of health information exchange. Too many options have caused too many barriers. That’s not just my opinion, by the way. I’m willing to bet that a sizeable chunk of the 37,537 HIMSS 14 attendees would agree with me.

Do you disagree? Are providers (and patients) better served by more IT options than less? Let me know your thoughts, and impressions of interoperability advancement at HIMSS, in the comments below.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A while back I came across an amazing fable called The Old Man and the Doctor. I was trying to think of a way I could use part of it to entice you to go and read the entire Fable, but there’s no way to take a piece of it. You just have to go and read the whole thing. It has a couple twists and turns that really shocked me. If you haven’t read it yet, go read it now. This post will be here when you’re done. (Note: I’d love to see an amazing story teller tell this Fable at a future TedMed).

While just a Fable, it highlights a real challenging problem that every doctor faces: mixing technology with human touch.

I know some people who are working really hard on trying to solve this problem. How do we get the granular data elements that we need to improve healthcare while still preserving the human touch of a doctor?

This is not an easy problem to solve, and I’m sorry to say that most EHR implementations often do more harm than good when it comes to the physician-patient relationship. Various reimbursement and regulation requirements aren’t helping either. No doubt the Fable above is warning us of this shift.

I think this problem can be solved if we’re aware of it and work to solve it. I don’t think it can be solved by one individual either. It like takes a mix of vendors, doctors, nurses, consultants, etc to make the patient visit experience more human while still meeting the documentation demands. Hopefully this amazing Fable will help more people to become aware of this challenge.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I can’t believe there’s a 30 point difference in usability. Really? No, I’m not talking about the difference. I’m talking about trying to put a number on EMR usability. Think how ridiculous that idea really is. An EMR is made up of 100s of functions and you’re going to take an EMR vendor’s usability and try and quantify it to a number. That’s just insane.

This is an awesome point that really highlights a bunch of the key challenges that happen in EMR implementations. There’s definitely a lot of blame and finger pointing that can happen. You have to battle against this for it not to happen.

This is a great article that can be summed up with: because they don’t have to care. That’s right. EHR sales are doing just fine, so they don’t have to worry about usability. Healthcare really has reached a point of acceptance of crappy technology. This will change one day, but I don’t see it changing at least until after meaningful use.

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

In the first part of this blog series, I outlined the increasingly important role CMIOs are playing in the hospital ecosystem. They are bridging the gap between the world of clinical and IT, bringing a spirit of impartiality to HIT implementations that often makes the acceptance of impending workflow upsets a little bit easier to swallow.

This second part will focus on the specific challenges CMIO panelists at a recent Georgia HIMSS luncheon were particularly vocal about:

* Taking an EMR implementation from grumbles to growth;
* Data and its potential impact on establishing or refining best practices;
* Patient engagement; and
* “If You Could Tell a CIO.”

From Grumbles to Growth
All the panelists shared their “secret ingredients” for EMR implementation success. Roland Matthews, MD, physician champion at Grady, stressed that the hospital chose to implement an EMR not for the Meaningful Use incentives, but to ultimately improve quality over the long term. Despite recent EMR backlash, Matthews is a firm believer in the benefit they will ultimately bring to patient care.

That being said, he believes that simpler, easier-to-use systems are the best choice when it comes to gaining full adoption amongst clinicians. His statement echoes the increasingly loud call from clinicians for better user experience. Involving all departments in the selection and implementation process from the very beginning is also essential, according to Matthews, and serves as a testament to good leadership.

The best user experience won’t take physicians very far, however, if infrastructure is too unreliable to sport it. While he didn’t claim to speak from personal experience, Matthews also pointed out the latest and greatest EMR may never be used to its fullest potential if the platform on which it stands is down half the time.

Steve Luxenberg, MD, CMIO at Piedmont Healthcare, made sure to point out the full value of an EMR can only be realized if clinical and IT work together to maintain, optimize, and grow the product from within.

This takes us to conversation points about extracting data to create or refine best practices in an effort to drive quality initiatives.

Digging Out Data to Increase Quality
“It’s not an EMR for the sake of an EMR,” Luxenberg emphasized. “It’s about the data we can pull out, interpret and impact outcomes with.”

Daniel Wu, part-time CMIO at Grady, echoed Luxenberg’s comments: “The EMR has opened a door to allow us to collect data as we’ve never been able to do before.” The panelists all agreed on this point, and now it seems as if they are tackling the issue of interpreting the data to enable better outcomes and quality.

Matthews insisted that collecting the data is really all about quality, and suggested that the EMR should guide standards, which the panelists referred to in the same context as best practices.

Wu made the point that if providers don’t control what designates quality care, or best practices, then the government will come along and regulate it for them. (I’m fairly certain this echoes what Farzad Mostashari has tweeted about in the recent past.)

Luxenberg again emphasized the impartiality CMIOs must take when dealing with clinical and IT staff. He noted the CMIO’s role is to bring the two groups together for consensus on what best practices are and how to put those into the EMR, and added this becomes more challenging when working in a multi-facility healthcare system.

Patient Engagement
Patient portals were on the tips of all the panelists’ tongues when it came to patient engagement. Julie Hollberg, MD, CMIO at Emory, is in the middle of rolling out a portal right now. Her team is finding the most challenging part of that implementation to be educating Emory patients on what benefits the portal offers. Luxenberg was a bit lukewarm with regard to patient portals. He’s seen several come and go and has found that only a certain set of patients is apt to use them.

Wu, who has helped implement Epic’s MyChart at Grady, was firm when he said that patients have the responsibility in their court now. Patient kiosks are helping in that effort, too.

What Would You Like Your CIO to Know?
Wu’s big point was that if CMIOs and CIOs can’t communicate, each is doomed to fail. He said it with a smile, of course, as his CIO, moderator Debbie Cancilla from Grady, was standing right next to him.

Other insights included:

* Keep IT simple for the clinicians.
* Just because you can do it doesn’t mean you should.
* Always keep in mind what’s best for the patient, and what’s the simplest way to get that done.
* It’s always a good idea to have IT folks shadow clinicians and vice versa. The CMIO’s job is to help facilitate this type of partnership.

How have CMIOs brought your clinical and IT teams together? Please share anecdotes and more best practices in the comments below.

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

It’s been interesting to see the evolution of conversation around healthcare IT at the provider-focused events I’ve attended over the last two years. Panels of hospital executives at first spoke about the benefits they were likely to see as a result of the HITECH Act and their facilities’ subsequent plans for EMR implementation. One-year later, it was all about best practices for go lives. Today, conversation has reached the “now what?” phase.

This was definitely top of panelists’ minds at the recent Georgia HIMSS Lunch & Learn, which offered attendees a hearty Italian meal and the chance to hear area CMIOs converse around the topic of “CMIO 2.0 – Leading Healthcare Transformation.” While “transformation” tends to be a bit overused, I think it was an apt word based on the remarks from moderator Debbie Cancilla, Senior VP and CIO at Grady Health System; Julie Hollberg, MD, CMIO at Emory Healthcare; Daniel Wu, part-time CMIO at Grady; Roland Matthews, MD, physician champion at Grady; and Steve Luxenberg, MD, CMIO at Piedmont Healthcare.

I hate to play favorites, but Wu was my favorite panelist. Calling himself the “least tech savvy CMIO in the country,” he was engaging and a good sport when it came to verbal sparring with his Grady colleague, Cancilla. No one in the audience was fooled by his self-deprecation, of course. Wu, who is also Assistant Medical Director at Grady’s Emergency Care Center, and Assistant Professor of Emergency Medicine at Emory University’s School of Medicine, knows a thing or two about healthcare IT, having put in an EMR for Grady’s emergency department. He continues to serve as a physician champion for the hospital.

Several telling themes emerged from panelists’ comments and audience questions, which I’ll share in part 1 of this post. I’ll cover challenges specific to each panelist and their facility next week in part 2.

Shining a Light on CMIOs
This was the first all-CMIO panel I’d ever seen, which may be indicative of their general reluctance to be put in the spotlight, and perhaps the increasingly important role they play in HIT implementations of all kinds. (I also wonder if the title of CMIO is growing. If anyone has statistics on that, please share.) Cancilla noted it was time for CMIOs to get in the healthcare transformation conversation, and while these four seemed at no loss for stories to tell and pain points to share.

CMIOs Don’t Play Favorites
When it comes to the clinical side of the house versus the IT side of the house, the panelists agreed that sometimes the two just don’t understand each other. And that’s where the CMIO steps in, acting as interpreter, smoother of ruffled feathers, and occasionally spokesperson for both departments to the higher ups. In describing his role, Luxenberg described himself as an objective third party, coming in to finesse sticky situations between clinical and IT staff. I got the impression from him that CMIOs often have more success in resolving disputes because they don’t have allegiance to one particular department, but rather the hospital as a whole.

(Sidenote: Wu mentioned a hilarious cartoon by Atlanta-based anesthesiologist Michelle Au that highlights the delicate verbal dance CMIOs must do when talking with various medical specialties. Check out “The 12 Medical Specialty Stereotypes.” It’s worth noting Wu would be considered a “cowboy.”)

Getting it Done for the Patient’s Benefit
Because they represent the interests of the hospital, these CMIOs ultimately hold themselves accountable to the patient, and benefiting the patient is a big part of the message they have to convey to clinical and IT folks, especially during times of implementation. Luxenberg noted that he gets better EMR buy in from different departments when he highlights the benefits to patient care, rather than focusing on details specific to one department in particular.

Talking with different departments does mean, however, that CMIOs must step out of their comfort zones and really get familiar with the pressures of each area within their facility. Conveying this information is where a great relationship with the CIO comes in. For the CMIO’s objectivity to truly be valuable, that assessment must be meaningfully discussed with the CIO. As Cancilla mentioned, CIOs need to step up and strengthen relationships with their CMIOs. All the panelists and Cancilla agreed the communication from the top down and bottom up is key to successful adoption of healthcare IT.

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

In light of this week’s “holiday,” I thought I’d take a look at the current love/hate relationship the healthcare industry seems to have with electronic medical records and Meaningful Use.

Thanks are due to @mdrache and @EHRworkflow for their inspiration for the title of this week’s post:

The nay sayers seem to have become especially vocal lately, which may be due in large part to the passing of time. Those that have implementations under their belt now feel qualified to talk about the efficacy of the solutions they selected. Negative EMR press may also have bubbled up to the service in light of the recent RAND report, which backpedaled on previous predictions of cost-savings associated with healthcare IT adoption. That study broke the ice, so to speak, and perhaps made providers more comfortable with voicing their discontent.

In any case, if current healthcare IT press is any indication, EMR technology currently on the market has often left providers dissatisfied for a number of reasons. No doubt this dissatisfaction will be a subject of many show-floor conversations at HIMSS in a few weeks. I wonder how EMR vendors are preparing their responses. What will be their top three talking points when it comes to EMR benefits? It seems Meaningful Use incentives have lost their luster, and in fact have left many providers disenchanted with healthcare IT in general.

John Lynn posted a very telling reader comment over at EMRandHIPAA.com from a provider who used his Meaningful Use malaise to create a new independent practice business model. Is this an indication that more providers may “revolt” against Meaningful Use and the trend towards hospital employment? If so, what will the private practice landscape look like in three to five years?

Just how easy is it for providers to truly “break up” with their EMRs? We’ve all read the multi-million-dollar rip-and-replace horror stories – talk about a bad breakup. And then there are the providers that stay in dysfunctional relationships with their EMRs because they can’t afford a new one, instead developing copious amounts of workarounds potentially at the expense of clinical care and accurate reimbursement.

As of last summer, KLAS reported that a whopping 50% of providers were looking to replace their ambulatory EMRs, compared to 30% in 2011. A recent Health Data Management webinar noted more than 30% of ALL new EMR purchases are made to replace an existing EMR.

To me, these numbers beg a number of questions. Were first- and perhaps even second-generation EMRs just not mature enough for providers’ needs? Did providers simply not do enough due diligence before making their purchases? Will these impending replacement EMR purchases stick? If you have updated EMR breakup statistics or a crystal ball, please send them my way.

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

It’s that time of year again. Like my mother, I’ve taken to scheduling any sort of annual event around the time of my birthday. So, now my birthday cake is accompanied by a trip to get my emissions done, a jaunt to the tag office, and a visit to my primary care doctor for an annual physical and any other female-related health services I might need. (Timely, considering that October is also Breast Cancer Awareness Month.)

I tend not to schedule my well visits months in advance, and so was a bit apprehensive earlier in the week as I dialed in to get an appointment. I’ve read quite a few patient horror stories lately of appointments not being available for months due to lack of staff. Thankfully, this was not my experience. I was able to pick the date and time of my choosing, with the only insurance-related caveat being that I had to wait until one day after the date of my exam in 2011.

When I was at the doctor’s office last year, they were in the process of launching a patient portal. Digging around on their website while speaking with their receptionist, I noticed the portal is indeed available. The patient-centric portal offers online bill pay, appointment scheduling and pre-registration services and a personal health record. I’ll be interested to see if they mention its availability when I am seen in a few weeks. I’ll definitely ask who was involved with the implementation, and if they’re looking to Stage 2 Meaningful Use quotas when it comes to electronic patient engagement.

But enough about me. The reason I bring all this up is because the Journal of the American Medical Informatics Association recently made available research on “The effect of electronic medical record system sophistication on preventive healthcare for women.” A quick look at the abstract relates that 29.23% of providers (culled from those in the National Ambulatory Medical Care Survey from 2007-08) had no EMR system, 49.43% had minimal EMRs, 15.97% had basic EMRS, and 5.46% had fully functional EMRs.

“For breast examinations, pelvic examinations, pap tests, Chlamydia tests, cholesterol tests, mammograms, and bone mineral density tests, an EMR system increased the number of these tests and examinations,” according to the abstract. “Furthermore, the level of sophistication increased the number of breast examinations and pap, Chlamydia, cholesterol and BMD tests.”

The JAMIA’s point being that “the use of advanced EMR systems in obstetrics and gynecology was limited. Given the positive results of this study, specialists in women’s health should consider investing in more sophisticated systems.”

I’m going to play devil’s advocate here for a minute.

First of all, the fact that not even 5.5% of providers surveyed had a fully functional EMR is dismaying, but perhaps I don’t understand the underlying financial reasons for their lack of adoption. And the fact that the survey was taken more than four years ago could play a part. It would seem to me that there would be much to gain clinically and financially in having a fully function EMR especially in obstetrics, where women are often seen at a number of facilities throughout their pregnancies.

And finally, I have to take issue with the “positive results” the JAMIA concludes the study to have had. To me, “positive” connotes “successful,” so I wonder if there’s a hidden conflict of interest here. Increased sophistication of EMR systems would seem to equal more tests, according to the study, but no mention is made of if those tests lead to better outcomes (a win for patients) or higher reimbursements (a win for providers). I know we walk a fine line when talking about EMRs, tests and money, and that it often ends up being a chicken-and-egg situation, but it’s still a debate that needs to be had, especially in the area of women’s health.

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Whatever level of knowledge you may possess about these rules and how near or far they deviate from those proposed, I think we can all agree that the EMR industry (developers and end-users) is suffering immense growing pains as vendors and physicians adjust to the Meaningful Use scheme. (I use that term in the British sense, by the way.)

Julie McGovern, CEO of Practice Wise, cleverly equated implementation of an EMR to being pregnant in a recent blog:

“In the beginning, you are tired and often feel like you have morning sickness. The first trimester is the hardest. In the second trimester, you start to get your legs under you, your energy starts to return, and you feel less beaten down by the EHR. By the third trimester, you start to see the light at the end of the tunnel, it’s starting to be second nature, the product is making more sense (hopefully), you’ve got good workflows and everyone is starting to forget how hard the first trimester was.”

I’ll go one step further and equate utilization (i.e. the regular use of an EMR after go-live) as relates to the various stages of Meaningful Use with bringing up that baby. I might even disagree with her – pregnancy is often the easy part (provided you’ve had no complications along the way, of course, be they IT, managerial, administrative, cultural or otherwise). You’ve got the PR-friendly ribbon-cuttings, parties and press releases that hospitals often initiate around their go-lives. Well-deserved events, to be sure. But then come the hard parts, when you and your colleagues integrate that new bundle of joy into your daily lives (i.e. workflows).

Eventually the EMR will develop its own personality, form bonds with its users, bring joy to many for the clinical outcomes it improves, and hopefully not cause too many tears of frustration along the way. Hopefully it will gossip with its peers at other hospitals, and even aspire to interoperate in the same circles as its distant cousin – health information exchange. You can bet that it will end up costing more money than you had anticipated – upgrades, add-ons, etc.

The years will go by – 2014 and 2016 will be here before you know it. Hopefully, the EMR that caused so much joy when it was first brought into this world shiny, new and virus-free will still bring a smile to the face of its users, and better care to the patients whose information it so closely guards.